Sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities, Sustaining

g the polio-free country for global certification Eliminating measles by 2008, Eliminating neonatal tetanus by 2008.

EPIDEMIOLOGICAL SITUATION The program is based on epidemiological situation; schedules are drawn on the basis of the occurrence and characteristic epidemiological features of the disease.

MASS APPROACH The whole community rather than just the individual is to be protected, thus mass approached is utilized.

BASIC HEALTH SERVICE Immunization is a basic health service and such it is integrated in to the health services being provided for by the Rural Health Unit

Target setting Cold chain logistic management Information, education and communication Assessment and evaluation of the programs overall performance

Presidental Decree No.996 providing for compulsary basic immunization for infants and children below eight years of age

Presidential Proclamation No. 6 implementing a United Nations goal on Universal Child Immunization by 1990

Presidential Proclamation No. 46 reaffirming the commitment of the Philippines to the Universal child and Mother Immunization Goal of the world health assembly

Presidential Proclamation No. 47 Declaring april 21 and may 19, 1993 and every third Wednesday of January and February thereafter, for 2 years, as National Immunization Days (Nids)

Republic Act 7486 an act requiring compulsary immunization against Hepatitis B for infants and children below 8 yrs. Old

Presidential Proclamation No.4 Declaring the peroid from September 16 to October 14 1998 as the Ligtas Tigdas Month and launching the Philippines Measles Elimination Campaign.

is an acute infectious disease caused by the bacteria Corynebacteriu m diphtheriae.

Diphtheria spreads through respiratory droplets (such as those produced by a cough or sneeze) of an infected person or someone who carries the bacteria but has no symptoms. Diphtheria can also be spread by contaminated objects or foods (such as contaminated milk). The bacteria most commonly infects the nose and throat. The throat infection causes a gray to black, tough, fiber-like covering, which can block the airways. In some cases, diphtheria may first infect the skin, producing skin lesions.

symptoms usually occur 2 to 5 days after you have come in contact with the bacteria. Bluish coloration of the skin Bloody, watery drainage from nose Breathing problems Difficulty breathing Rapid breathing Stridor Chills Croup-like (barking) cough

 Drooling

(suggests airway blockage is about to occur) Fever Hoarseness Painful swallowing Skin lesions (usually seen in tropical areas) Sore throat (may range from mild to severe) Note: There may be no symptoms.

Risk

factors include crowded environments, poor hygiene, and lack of immunization.

Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep "whooping" sound is often heard when the patient tries to take a breath.

Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussisbacteria. It is a serious disease that can cause permanent disability in infants, and even death. When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person.

initial symptoms, similar to the common cold, usually develop about a week after exposure to the bacteria. Severe episodes of coughing start about 10 to 12 days later. In children, the coughing often ends with a "whoop" noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults.

The infection usually lasts 6 weeks.

Whooping cough can affect people of any age. Before vaccines were widely available, the disease was most common in infants and young children. Now that most children are immunized before entering school, the higher percentage of cases is seen among adolescents and adults.

Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells are common.

Other pertussis symptoms include: Runny nose Slight fever (102 F or lower) Diarrhea

a highly infectious viral disease, which mainly affects young children. The virus is transmitted through contaminated food and water, and multiplies in the intestine, from where it can invade the nervous system. Many infected people have no symptoms, but do excrete the virus in their faeces, hence transmitting infection to others.

 Initial

symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. Polio can only be prevented by immunization.

Vaccine

Minimum Age at 1st Dose

Number of Doses

Dose

Minimum Interval Between Doses

Route

Site

Reason

BACILLUS Birth or CALMETTE anytime after -GURIN birth

0.05 mL

--

BCG given at earliest possible Right age protects the deltoid possibility of TB Intradermal region of meningitis and the arm other TB infections in which infants are prone

Content: Live attenuated bacteria

Form & Dosage Freeze dried infant- 0.05ml

Vaccine

Minimum Age at 1st Dose

Minimum Number Interval of Dose Between Doses Doses

Route

Site

Reason

DIPHTHERIAPERTUSSIS6 weeks TETANUS VACCINNE

0.5 mL

An early start with Upper Intra outer DPT reduces 4 weeks portion of the chance muscular the thigh of severe pertussis.

Content: DT- weakened toxin P-killed bacteria

Form & Dosage liquid-0.5ml

Vaccine

Minimum Age at 1st Dose

Number of Doses

Dose

Minimum Interval Between Doses

Route

Site

Reason

ORAL POLIO VACCINE Content: 6 weeks weakened virus 3 2-3 drops 4 weeks Oral Mouth

The extent of protection against polio is increased the earlier the OPV is given. Keeps the Philippines polio-free.

Vaccine

Minimu m Age at 1st Dose

Number of Doses

Dose

Minimum Interval Between Doses

Route

Site

Reason

HEPATITIS B VACCINE
Content: plasma derivative
6 weeks 3

0.5 mL Liquid form

An early start of Hepatitis B vaccine reduces the chance of being infected and 6 weeks interval becoming a carrier. from Prevents liver cirrhosis Upper 1st dose to 2nd and liver cancer which outer Intramusc dose, are more likely to portion of 8 weeks interval ular develop if infected with the thigh from Hepatitis B early in life. 2nd dose to third About 9,000 die of dose. complications of Hepatits B. 10% of Filipinos have Hepatitis B infection

Vaccine

Minimum Age at 1st Dose

Number of Doses

Dose

Minimum Interval Between Doses

Route

Site

Reason

MEASLES VACCINE (not MMR) Content:

Weakened virus

0.5 mL 9 months 1 Freeze dried --

At least 85% Upper of measles outer can be Subcutan portion eous prevented by of the immunization arms at this age.

Because measles kills, every infant needs to be vaccinated against measles at the age of 9 months or as soon as possible after 9 months as part of the routine infant vaccination schedule. It is safe to vaccinate a sick child who is suffering from a minor illness (cough, cold, diarrhea, fever or malnutrition) or who has already been vaccinated against measles

If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule should be resumed using minimal intervals between doses to catch up as quickly as possible

Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less than 20 mg per day), minor infections with low fever (below 38.5 Celsius), diarrhea, malnutrition, kidney or liver disease, heart or lung disease, non-progressive encephalopathy, well controlled epilepsy or advanced age, are not contraindications to vaccination. Contrary to what the majority of doctors may think, vaccines against hepatitis B and tetanus can be applied in any period of the pregnancy

There are very few true contraindication and precaution conditions. Only two of these conditions are generally considered to be permanent: severe (anaphylactic) allergic reaction to a vaccine component or following a prior dose of a vaccine, and encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination

Vaccine

Minimum Age/Interval

Percent Protected

Duration of Protection

TT1

As early as possible during pregnancy At least 4 weeks later

-

-infants born to the mother will be protected from neonatal tetanus gives 3 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 5 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 10 years protection for the mother gives lifetime protection for the mother all infants born to that mother will be protected

TT2

80%


TT3

At least 6 months later

95%


TT4

At least 1 year later

99%


TT5

At least 1 year later

99%

There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately. Malnutrition is not a contraindication for immunizing children rather, it is an indication for immunization since common childhood diseases are often severe to malnourished children.

Use those that will expire first, mark X/ exposure, 3rd- discard, Transport-use cold bags, let it stand in room temperature for a while before storing DPT. Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.

Vaccine temperature is monitored twice a day (early in the morning and in the afternoon) in all health facilities and plotted to monitor break in the cold chain. Each level of health facilities has cold chain equipment for use in the storage vaccines which included cold room, freezer, refrigerator, transport box, vaccine carriers, thermometers, cold chain monitors, ice packs, temperature monitoring chart and safety collector boxes.

In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is because of which legal document? A. P.D. 996 B. R.A. 7846 C. Presidential Proclamation No. 6 D. Presidential Proclamation No. 46

 Answer:

(A) P.D. 996 Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846.

 Which

immunization produces a permanent scar? DPT B. BCG C. Measles vaccination D. Hepatitis B vaccination

A.

Answer: (B) BCG BCG causes the formation of a superficial abscess, which begins 2 weeks after immunization. The abscess heals without treatment, with the formation of a permanent scar.

4-week old baby was brought to the health center for his first immunization. Which can be given to him? DPT1 B. OPV1 C. Infant BCG D. Hepatitis B vaccine 1

A.

Answer: (C) Infant BCG Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6 weeks of age.

. You will not give DPT 2 if the mother says that the infant had A. Seizures a day after DPT 1. B. Fever for 3 days after DPT 1. C. Abscess formation after DPT 1. D. Local tenderness for 3 days after DPT 1

Answer: (A) Seizures a day after DPT 1. Seizures within 3 days after administration of DPT is an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT.

A 2-month old infant was brought to the health center for immunization. During assessment, the infants temperature registered at 38.1C. Which is the best course of action that you will take? A. Go on with the infants immunizations. B. Give Paracetamol and wait for his fever to subside. C. Refer the infant to the physician for further assessment. D. Advise the infants mother to bring him back for immunization when he is well.

Answer: (A) Go on with the infants immunizations. In the EPI, fever up to 38.5C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.

A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long? A. 1 year B. 3 years C. 10 years D. Lifetime

Answer: (A) 1 year The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection.

Unused BCG should be discarded how many hours after reconstitution? A. 2 B. 4 C. 6 D. At the end of the day

Answer: (B) 4 While the unused portion of other biologicals in EPI may be given until the end of the day, only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is scheduled only in the morning.

. Which biological used in Expanded Program on Immunization (EPI) is stored in the freezer? A. DPT B. Tetanus toxoid C. Measles vaccine D. Hepatitis B vaccine

Answer: (C) Measles vaccine Among the biologicals used in the Expanded Program on Immunization, measles vaccine and OPV are highly sensitive to heat, requiring storage in the freezer.

. Which disease was declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines? A. Poliomyelitis B. Measles C. Rabies D. Neonatal tetanus

Answer: (B) Measles Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.

Management of a child with measles includes the administration of which of the following? A. Gentian violet on mouth lesions B. Antibiotics to prevent pneumonia C. Tetracycline eye ointment for corneal opacity D. Retinol capsule regardless of when the last dose was given

Answer: (D) Retinol capsule regardless of when the last dose was given An infant 6 to 12 months classified as a case of measles is given Retinol 100,000 IU; a child is given 200,000 IU regardless of when the last dose was given.

Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer? A. DPT B. Oral polio vaccine C. Measles vaccine D. MMR

Answer: (A) DPT DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2 to 8 C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on Immunization.